Duplex scans before subclavian vein catheterization predict unsuccessful catheter placement
W. D. Haire, T. G. Lynch, R. P. Lieberman and J. A. Edney
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68198-3330.
Subclavian catheterization in patients with cancer is associated with up to
a 38% incidence of subclavian vein thrombosis. These thrombi seldom
recanalize. The persistent occlusion of the subclavian vein may hinder
subsequent catheter placement. To determine the frequency of this
occurrence and to determine if preoperative duplex scanning could identify
these individuals, we performed preoperative duplex scanning in 22 patients
who had previously had an indwelling subclavian catheter for chemotherapy.
Subsequent subclavian vein catheterization was attempted without knowledge
of the results of the duplex scan. Nineteen scans were normal. Of these, 18
patients underwent successful catheter placement. In one patient,
catheterization was unsuccessful and an intraoperative venogram showed a
focal obstruction of the proximal portion of the subclavian vein. Three
scans showed noncompressibility of the vein, and catheter placement was
unsuccessful in these three veins. In patients who have had previous
subclavian catheters, persistent obstruction of the vein prevents
subsequent catheter placement in 14%. Duplex scanning before subsequent
catheter placement generally identifies these individuals.
